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5.
Common Tubes
Table or Apparatus
Miller-Abbott tube
Purpose
Longer than Levin
tube; has mercury of
air in bags so tube can
be used to decompress
the lower intestinal
tract
Examples of Use
1. Small-bowel
obstructions
2. Intussusception
3. Volvulus
Cantor Tube
To drain bile from the
common bile duct
until edema has
subscribed
Cholecystectomy
when a common duct
exploration (CDE) or
choledochostomy was
also done
T-tube
A type of closedwound drainage
connected to suctionused to drain, a large
amount of
serosa`nguineous
drainage from under
an incision
1. Mastectomy
2. Total hip
procedure
3. Total knee
procedure
Hemovac
A method of closed
wound suction
drainage indicate
when tissue
displacement and
tissue trauma may
1.
2.
3.
4.
Neurosurgery
Neck surgery
Mastectomy
Total knee and hip
replacement
5. Abdominal surgery
Key points
1. Care similar to that
Levin NG tube
irrigated.
2. connected to
suction, not sterile
technique
3. orders will be
written on how to
advance the tube
gently pushing
tube a few inches
each hour, patient
position may affect
advancement of
tube
4. X-rays determine
the desired
location of tube
1. Bile drainage is
influenced by
position of the
drainage bag.
2. Clamp tubes as
ordered to see if
bile will flow into
duodenum,
normally.
1. May compress
unit, and have
portable vacuum or
connect to wall
suction.
2. Small drainage
tube may get
clogged physician
may irrigate these
at times
Empty reservoir when
full, to prevent loss of
wound drainage and
back contamination

6.
Jackson-Pratt
Three-way Foley
Suprapubic catheter
Ureteral catheter
occur with rigid drain
tubes (e.g Hemovac)
See Hemovac
To provide avenues
for constant irrigation
and constant drainage
of urinary bladder
6. Urological
procedure
See Hemovac
1. Transurethral
resection (TUR)
2. Bladder infection
To drain bladder via
an opening through the
abdominal wall above
the pubic bone
To drain urine feom
the pelvis of one
kidney, or for splinting
ureter
Suprapubic
prostatectomy
1. Cystoscopy for
diagnostic
workups
2. Ureteral surgery
3. Pyelotomy
See Hemovac
Watch for blocking by
clots causes bladder
spasms
Irrigant solution often
has antibiotic added to
normal salin or sterile
water
Sterile water rather
than normal saline
may be used for lysis
of clots
May have orders to
irrigate prn or
continuously
Never clamp the tubepelvis of kidney only
holds 4-8 mL
Use only 5 mL sterile
normal saline if
ordered to irrigate
Common Diagnostics Procedures
Noninvasive Diagnostic Procedures
Characteristics:
1. it provides an indirect assessment of organ size, shape, and / or function
2. it is safe
3. it is easily reproducible
4. it requires less complex equipment for recording
5. it does not require the written consent of patient or guardian
General Nursing Tasks:
1. Decrease patients anxieties and offer support by
a. Explain purpose and procedure of test
b. Acknowledge questions regarding safety of the procedure
c. Remain with the patient while the procedure is going on
2. Use procedure in the collection of specimens that avoids contamination
A. Graphic studies of Heart and brain
1. Electrocardiogram (ECG) – graphic record of electrical activity generated by the heart
during depolarization and repolarazation.
- diagnose abnormal cardiac rhythms and coronary heart disease

7.
2. Echocardiography (ultrasound cadiography) – graphic record of motions produced by
cardiac structure as high-frequency sound vibrations are echoed though chest wall into the
heart.
- used to demonstrate valvular or other structural deformities, detect pericardial
effudion, diagnose tumors and cardiomegaly, evaluate prosthetic valve function.
3. Electroencephalogram (ECG) – graphic record of the electrical potentials generated by the
physiological activity of the brain
- used to detect surface lesions or tumors of the brain and presence of epilepsy.
4. Echoencephalogram – beam of ultrasound is passed though the head, and returning echoes
are graphically recorded.
- used to detect subdural hematomas, intracerebral hemorrhage, or tumors.
B. Roentgenological studies (X-ray)
1. Chest – used to determine size, contour of the heart; size, location, and nature of pulmonary
lesions: pleural thickening and effusions: pulmonary vasculature: disorder of thoracic ones
and soft tissues.
- used lead shield to protect pregnant woman
2. Kidney, Ureter, and Bladder (KUB) – used to determine size, shape, and position of
kidney, ureter and bladder
- No special consideration
3. Breast (Mammography) – examination of the breast with or without the injection of the
radiopaque substance into the duct of mammary gland.
- used to determined the presence of tumor or cyst (best done a week after
menstruation)
- no deodorant, perfume, powder, or ointment in underarm area on the day of X-ray
(contains Calcium oxalate)
- May be uncomfortable due to the pressure on the breast. (uses two x-ray plates)
C. Roentgenological studies (FLUOROSCOPY) – requires the ingestion or injection of a
contrast medium to visualize the target organ.
Additional Nursing Task:
a. Administration of enemies or cathartics before the procedure and laxative after.
b. Keeping the patient NPO 6-12 hours before examination
c. Ascertain patient’s allergy and allergic reactions
d. Observing for allergic reactions to contrast medium
e. Providing fluid and food after procedure to prevent dehydration
f. Observe stool for color and consistency until barium passes
1. Upper GI (Barium swallow) – ingestion of barium sulfate or meglumine diatrizoate
(Gastrografin [white and chalky substance], followed by fluoroscopic and x-ray
examination)

8.
-
used to determine patency and caliber of the esophagus and to detect esophageal
varices, mobility of gastric wall, presence of ulcer, filling defects due to tumor,
patency of pyloric valve and presence of structural abnormalities
2. Lower GI (Barium Enema) – rectal instillation of barium sulfate followed by
glouroscopic and x-ray examination
- used to determine contour and mobility of colon and presence of any spaceoccupying tumors. Perform before upper GI
Patients preparations:
- no food after evening meal the evening before the test
- stool softener laxatives and enema suppositories to cleanse the bowel before the test
- NPO after midnight before the test
After care:
-
increased fluid intake, food and rest
laxatives for at least two days or until stools are normal in color and consistency
3. Cholecystogram – ingestion of organic iodine contrast medium (Telepaque) followed in
12 hour by x-ray visualization
- gallbladder disease is indicated with poor or no visualization of the bladder
- accurate only if GI and liver function is intact
- perform before barium swallow and barium enema
Patients preparations:
- administer large amount of water with contrast capsule
- low-fat meal before evening before x-ray
- oral laxative of stool softener after meal
- no food allowed after contrast capsule
After care:
-
increased fluid intake, food and rest
observe for any untoward reactions
4. Intravenous Pyelography (IVP) – injection of a radiopaque contrast medium in the vein
of the client to visualize ureter, bladder and kidney
Patients preparations:
- Laxative in the evening before the examination
- NPO for 12 hours
- Cleaning enema morning of the procedure
After care:
-
increased fluid intake, food and rest;
observe for any untoward reactions

9.
D. Computed Tomography (CT) – an x-ray beam sweeps around the body, allowing measuring
of various tissue densities. Provides clear radiographic deficition of structures that are not
visible by other techniques.
- initial scan may be followed by “contrast enhancement” using an injection of
contrast agent iodine via vein, followed by a repeat scan.
Patients preparations:
- instructions for eating before test vary
- clear liquids up to 2 hours before the procedure are permitted
E. Magnetic resonance imaging (MRI) – noninvasive technique that produces cross sectional
images by exposure to magnetic energy sources. It uses no contrast medium; takes 30-0
minutes to complete. Patient may still for periods of 5-20 minutes at a time.
Patients preparations:
- patient can take food and medications except for low abdominal and pelvic studies
(food and fluid withheld) 4-6 hr to decrease peristalsis)
- Restrictions
a. those who have metal implants
b. those with permanent pacemakers
c. those who are pregnant
F. Ultrasound (sonogram) – uses sound waves to diagnose disorders of the thyroid, kidney,
liver, uterus, gallbladder, fetus and intracranial structures of the neonate.
Patients preparations:
- advise client not to chew gum or smoke before the procedure
- no x-ray
- for gallbladder studies; NPO for 8 hours
- for lower abdomen and uterus ; 32 ounces of water PO 30 minutes before the
procedure
G. Pulmonary function studies
• Ventilatory studies – use of incentive spirometer to determine how well the lung is
ventilating.
1. Vital capacity (VC) – largest amount of air that can be expelled after maximal
inspiration
Normal = 4000 – 5000 mL.
Decrease = indicate lung disease
Increase or decrease = indicate chronic obstructive lung disease
2. Forced expiratory volume (FEV) – percentage of vital capacity that can be forcibly
expired in 1, 2, or 3 seconds.
Normal =
80 – 83% in 1 sec
90 – 94% in 2 sec

11.
Common Diagnostics Procedures
Invasive Diagnostics Procedures
Characteristics:
1. it directly records the size, shape and function of an organ;
2. it requires the written consent of the patient or guardian;
3. it may result in morbidity and occasionally death.
General Nursing Task:
1. Before procedure:
a. have patient sing permit to procedure
b. ascertain and repot any patient history of allergy or allergic reaction
c. explain procedure briefly and accurately
d. explain that contrast medium might cause flushing or warm feeling
e. keep patient NPO 6-12 hour before procedure if anesthesia is to be used
f. allow patient to verbalize concerns
g. administer preprocedure sedatives, as ordered
h. if procedure done at bed side:
- remain with patient and offer reassurance
- assist with optimal positioning of patient
- observe for indication of complications – shock, pain and dyspnea
2. After procedure:
a. observe and record vital signs
b. check injection or biopsy sites for bleeding, infection, tenderness, or thrombosis
• report untoward reaction to the physician
• apply warm compress to ease discomfort, as ordered
c. if tropical anesthesia is used during procedure, do not give food or fluid until gag
reflex returns
d. encourage relaxation by allowing patient to discuss experience and verbalize
feelings.
A. Procedures to evaluate the cardiovascular system
1. Angiography – intravenous injection of radiopaque solution or contrast for the purpose
of studying its circulation through the patient’s heart, lungs and great vessels.
- Used to check the competency of the heart valves, diagnose congenital septal
defects, study heart function and structure before cardiac surgery, detect occlusions
of coronary arteries.
2. Cardiac catheterization – insertion of a radiopaque catheter into a vein to study the
heart great vessels.
- Used to confirm diagnosis of heart disease and determine extent of disease,
measure pressures in the heart chamber and great vessels, obtain estimate of cardiac
output, and obtain blood samples to measure oxygen content.
a. Right heart catheterization – catheter is inserted through a cut-down in the
antecubital vein into the superior vena cava, through the right atrium and
ventricle and into the pulmonary activity.

12.
b. Left-heart catheterization- catheter maybe passed retrograde to the left
ventricle through the brachial and femoral artery, it can be passed through
the left atrium after right-heart catherization by means of a special needle
that punctures the septa; or it may be passed directly into the left ventricle
by means of a posterior puncture.
Specific nursing considerations:
1. Preprocedure patient teaching:
a. Fatigue is a common complaint due to lying still for 3 hr
b. Feeling of fluttery sensation while the catheter is passed back into the left
ventricle
c. Flushed, warm feeling may occur when contrast medium is injected.
2. Postprocedure observations:
a. monitor ECG pattern for arrhythmias
b. check extremities for color and temperature, peripheral pulses for quality.
3. Angiography (Arteriography) – injection of a contrast medium in to the arteries to
study the vascular tree.
- Used to determine obstructions or narrowing of peripheral arteries.
B. Procedure to evaluate the respiratory system
1. Lung scan – injection of radioactive isotope into the body, followed by lung scintiscan,
which produces a graphic record of gamma rays emitted by the isotopes in the tissues.
- used to determine lung perfusion when pulmonary emboli and infarctions are
suspected.
2. Pulmonary angioghraphy – x – ray visualization of the pulmonary vasculature after the
injection of a radiopaque contrast medium.
- used to evaluate pulmonary disorders such as pulmonary embolism, lung tumor and
aneurysms, and changes in the pulmonary vasculature due to such conditions as
emphysema.
3. Bronchoscopy – introduction of a fiberoptic scope into the trachea and bronchi
- used to inspect tracheobronchial tree for pathological changes, remove foreign
bodies or mucous plugs causing airway obstruction, and apply chemotherapeutic
agents.
a. Prebronchoscopy interventions:
• oral hygiene
• postural drainage as indicated
b. Postbronchoscopy interventions:
• Instruct patient not to swallow oral secretions
• Save expectorated sputum for laboratory analysis
• NPO till gag reflex returns
• Observe for subcutaneous emphysema and dyspnea

13.
•
Apply ice collar to reduce throat discomfort
4. Thoracentesis – needle puncture through the chest wall and into the pleura
- used to remove fluid and occasionally air from the pleural space
- nursing considerations
a. position : high fowler’s position or sitting upon edge of the bed, with feet
supported on the chair.
b. If the patient is unable to sit up – turn unto unaffected side
a. Position: high fowler’s position or sitting upon edge of the bed, with feet supported on
the chair.
b. If the patient’ is unable to sit up-turn unto unaffected side
C. Procedures to evaluate the renal system
1.
Renal angiogram – small catheter is inserted into the femoral artery and passed into
the aorta or renal artery, radiopaque fluid is in stilled, and serial films are taken.
- Used to diagnose renal hypertension and pheochromocytoma and differentiate renal
cyst from tumors.
Postangiogram nursing actions:
1. Check pedal pulse for signs of decreased circulation.
2. Cystoscopy – Visualization of bladder, urethra, and prostatic urethra by insertion of a
tubular, lighted, telescopic lens (cystoscope) through the urinary meatus.
- Used to directly inspect the bladder; collect urine from the renal pelvis; obtain biopsy
specimens from bladder and urethra; remove calculi; and treat lesions in the bladder,
urethra, and prostate.
Nursing actions following procedure:
• Observe for urinary retention
• Warm sitz baths to relieve discomfort
3. Renal biopsy – needle aspiration of tissue from the kidney for the purpose of
microscopic examination.
Procedures to evaluate the digestive system:
1. Esophagoscopy and gastroscopy – visualization of the esophagus, the stomach,
and sometimes the duodenum by means of a lighted tube inserted through the
mouth.
2. Proctoscopy – visualization of rectum and colon by means of a lighted tube
inserted through the anus.

14.
3. Peritoneoscopy – direct visualization of the liver and peritoneum by means of a
peritoneoscope inserted through an abdominal stab wound.
4. Liver biospsy – needle aspiration of tissue for the purpose of microscopic
examination; used to determine tissue changes, facilitate diagnosis, and provide
information regarding a disease course.
Nursing action:
1. Place patient on right side and position pillow for pressure, to prevent bleeding.
5. Paracentesis – needle aspiration of fluid from the peritoneal cavity used to relieve
excess fluid accumulation or for diagnostic studies.
a. Specific nursing actions before paracentesis:
a. Have patient void - to prevent possible injury to bladder during
procedure
b. Position – sitting up on side of bed, with feet supported by
chair.
c. Check vital signs and peripheral circulation frequently
throughout procedure
d. Observe for signs of hypovolemic shock – may occur due to
fluid shift from vascular compartment following removal of
protein – rich ascitic fluid.
b. Specific nursing actions following paracentesis:
a. Apply pressure to injection site and cover with sterile dressing.
b. Measure and record amount and color of ascitic fluid; send
specimens to lab for diagnostic studies.
D. Procedures to evaluate the reproductive system in women
1. Culdoscopy – surgical procedure in which a culdoscope is inserted into the
posterior vaginal cul-de-sac
- Used to visualize uterus, fallopian tube, and peritoneal contents.
2. Breast biopsy – needle aspiration or incisional removal of breast tissue for
microscopic examination.
- used to differentiate among benign tumors, cysts, and malignant tumor in the
breast.
3. Uterotubal insufflation (Rubin’s Test) – injection of carbon dioxide into the
cervical canal.
- Used to determin fallopian tube patency
E. Procedure to evaluate the neuroendocrine system
1. Cerebral angiography – fluoroscopic visualization of the brain vasculature
after injection of a contrast medium into the carotid or vertebral arteries
- used to localize lesions (tumors, abscesses, and occlusions) that are large enough
to distort cerebrovascular blood flow.

15.
2. Myelogram – through a lumbar-puncture needle, a contrast medium is injected into
the subarachnoid space of the spinal column to visualize the spinal cord.
- Used to detect herniated or ruptured intervertebral disks, tumors and cysts that
compress or distort spinal cord.
Nursing consideration:
• Elevate head of bed = with water soluble contrast
• Flat position – with oil contrast
• V/s every 4 hr for 24 hr.
3. Lumbar puncture – puncture of the lumbar subarachnoid space of the spinal
cordwith a needle to withdraw samples of cerebrospinal fluid.
- Used to evaluate CSF for infections and determine presence of hemorrhage.
Note: not done if increased ICP is suspected
Position: Before : fetal position / knee chest position
After : flat or supine
Test
Antigen skin
Benedict’s test
Bentonite Flacculation Test
Beutler’s test
Blanching test
Bronsulpthalein test
Caloric test
CD4 determination
Cerebral perfusion test
Coomb’s test
CPK BB
CPK MB
CPK MM
Dark field illumination test and
kalm test
Dick test
Dull’s eye test
ELISA test
Gram staining and Culture of
Indication
Test to rule-out cancer of the lungs
For glucose monitoring
Test for filariasis
Test for galactosemia
Determines the impairment in circulation
Liver angiography
Test done by placing water in the ear canal causes nystagmus.
A test for inner ear
Checking the immune status to AIDS patient
Test used to check the cerebral function
Determines the production of the antibodies. RhoGAM is
given (1st 72 hours)
Test for brain muscles
Test for cardiac muscles: for MI
Test for muscle injury
Determination for the presence of syphilis
Detect scarlet fever
Determines the presence of blindness. Done in 1st ten days (+)
normal (-) abnormal
Determines presence of HIV
Determination for the presence of gonorrhea

16.
cervical and urethral smear
Gross hearing test
Guthrie test
Heat and Acetic acid test
Immunochromatographic test
Jones Criteria
Lepronin test
Liver enzyme test
Liver profile test
Lumbar puncture
Malaria smear
Mantoux test
Meniere’s test
Methylene blue test
Moloney test
Oxytocin challege test
Pandy’s test
Phenosulpthalein test
Queckkenstedt’s test
Rectal swab
Rinne Test
Romberg’s test
Schick test
Schiller’s test
Schilling test
Schwabach test
Shake test
Skin test
Slit skin smear
Specific gravity test
Sperm count test
Sputum exam
Sulkowitch test
Sweat chloride test
Tensilon (Endophonium) test
Tonometer
Test used by whispering words or spoken voice test
Test for PKU
For protein or albumin detection
A rapid assessment method done for filariasis. The antigen test
that can be done at daytime
One way of diagnosing Rheumatic heart fever
A screening test for leprosy
For SGOT and SGPT
Determines Hepa-b surface antigen
Determines for the presence of meningitis and encephalitis.
Position the patient in side lying position
Test to confirm malaria; specimen is taken at the height or
peak of fever
Determination for TB exposure
Test for vestibular function
For ketone detection
Hypersensitivity test for Diphtheria
Determines if the fetus can tolerate uterine contraction; (+) CS
is necessary
Determines the presence of protein in the CSF
Kidney angiogram
Test that involve the compression of jugular veins
Done in patient with cholera, pinworm detection
Shifted between mastoid bone and two inches from the ear
canal opening
Assess gait and station such as ataxia
Susceptibility test for diphtheria (+) no immunity (-) with
immunity
Staining the cervix with an iodine solution. Healthy tissues will
turn brown, while cancerous tissue resist the stain
Used to patient with severe chilling sensation; for confirmation
of pernicious anemia
Differentiate between conductive and sensorineural deafness,
mastoid of patient and examiner
Determines the amount of surfactant in the lungs.
Purpose it to produce antigen reaction
A confirmatory test for leprosy
For diabetes mellitus and insipidus as well as for dehydration
For male infertility (low sperm count-oversex)
For defection and sensitivity of causative microorganism, for
pneumonia and TB
Urine test detection for calcium deficiency and calcium in the
urine
Used to diagnosed cystic fibrosis
For rapid detection of myasthenia gravis
Test used to measure ocular tension and helping in detecting